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The WellBeing of the Paramedic


Cooking makes starches easier to digest. Generally healthy intake 300 grams/day ... Setting aside some 'personal time' for meditation and contemplation can greatly ... – PowerPoint PPT presentation

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Title: The WellBeing of the Paramedic

The Well-Being of the Paramedic
I wish we had a one-man stretcher!
Wellness Components
  • Physical well-being
  • and
  • Mental and emotional health
  • The physical as well as mental emotional health
    are critical to the EMS providers health and
    safety in order to function during stressful times

Physical Well-Being
  • Several factors play a major role
    in maintaining physical health
  • Good nutrition
  • Physical fitness
  • Adequate sleep
  • Disease prevention
  • Injury prevention

Assessing Your Risk Factors
  • Gives valuable insight into your personal
  • Assess for
  • pertinent family history
  • symptoms/conditions currently present
  • daily levels of exercise activity/commitment
  • diet body mass index
  • lifestyle habits (smoking, stress, activity,

  • Nutrients
  • Foods that contain elements necessary for body
  • Six categories
  • Carbohydrates
  • Fats
  • Proteins
  • Vitamins
  • Minerals
  • Water

  • Composed of carbon, hydrogen,
    and oxygen
  • Primarily are obtained from
    plant foods
  • Lactose (milk sugar) only important
  • source of animal carbohydrate
  • Plants store carbohydrates as starch
  • Cooking makes starches easier to digest
  • Generally healthy intake lt300 grams/day

Fats Fatty Acids
  • Fats in food are mixtures of three types of fatty
  • ?Saturated fat - primarily found in meat dairy
  • raises cholesterol levels should be avoided
  • ?Polyunsaturated - found in safflower, sunflower,
    corn soybean, cottonseed oils some fish
  • helps body rid self of newly formed cholesterol

Fats Fatty Acids
  • ?Monounsaturated fats - liquid vegetable oils
    such as canola and olive
  • these may decrease cholesterol levels
  • The 3 types of fats differ in chemical makeup and
    in the types of foods in which they appear
  • Daily fat intake
  • total fats limited to 65 grams/day
  • saturated fats limited to 20 grams/day

  • Present in all foods of animal origin
  • Heavily concentrated in fat and in poultry skin
  • White, waxy substance found in every cell
  • Needed by the body for normal functioning
  • Manufactured in liver and is
    carried through bloodstream
  • High blood cholesterol levels
    increase risk of heart disease and
  • stroke (healthy level is lt200 borderline
  • high is 200-239 unhealthy is gt240)

  • HDL (average normal men - 45 women - 55)
  • good (healthy) cholesterol
  • helps carry LDL away from arteries
  • LDL (optimal level is lt100)
  • bad cholesterol
  • deposits on artery walls
  • Triglycerides (normal is lt150)
  • much of the bodys fat is stored in the form of
    triglycerides for later use as energy

  • Composed of hydrogen, oxygen, carbon, and
  • Most also contain sulfur and phosphorus
  • Essential to building body tissue during growth,
    maintenance, and repair
  • When digested, breaks down into
    amino acids
  • Classified as either essential
    or nonessential
  • Daily intake adequate at
  • 50 grams/day

Amino Acids
  • Essential amino acids
  • Absolutely necessary for body growth and cellular
  • Must be obtained in food since they are not
    produced in body
  • Nonessential amino acids
  • Can be manufactured in the body

Proteins/Amino Acids
  • Proteins that contain all essential amino acids
    are complete proteins
  • Meats and dairy products
  • Proteins that are missing one or more essential
    amino acids are incomplete proteins
  • Grains and vegetables
  • Proteins can be used
    a source of energy

  • Organic substances present in minute amounts in
  • Must be obtained in food or through vitamin
  • Essential for metabolism
  • Cannot be produced in adequate
    amounts by the body
  • Vitamins classified as
  • Water-soluble
  • Fat-soluble

Water-Soluble Vitamins
  • Eight water-soluble vitamins in vitamin C and B
  • Water-soluble vitamins
    cannot be stored in the body
  • Must be provided
    by daily diet

Fat-Soluble Vitamins
  • Vitamins A, D, E, and K
  • Can be stored in the body
  • Therefore, daily dietary intake of these vitamins
    not required

  • Inorganic elements that play an essential role in
    biochemical reactions in the body
  • Include calcium, chromium, iron, magnesium,
    potassium, selenium, sodium, and zinc
  • Like vitamins, minerals
    are obtained through
    the diet

  • Most important nutrient because cellular function
    depends on a fluid environment
  • Composes 50 to 60 of total body weight
  • Infants have the greatest percentage
    of body
    water older adults
    have the least
  • Obtained through consumption
    of liquids and fresh fruits
  • Also is produced when food is
    oxidized during digestion
  • Basic rule for consumption
  • 21/2 - 31/2 liters of fluid/day

Food Groups
  • Food Pyramid- rough guideline periodic revisions
  • 5major food groups
  • Dairy products
  • 2-3 servings/day
  • Meat, fish, poultry
  • 2-3 servings/day
  • Vegetables
  • 3-5 servings/day
  • Fruits
  • 2-4 servings/day
  • Grains
  • 6-11 servings /day

Food Labels
  • Check serving size listed to avoid
    misinterpreting information
  • Reading labels helps consumer choose food wisely

Principles of Weight Control
  • Ideal weight controversial
  • Should be used only as a guide
  • People who are overweight tend
    to be at greater risk for developing
  • High blood pressure
  • Diabetes mellitus
  • Heart disease
  • Some cancers
  • Other illnesses

Ideal Body Weight
  • Common measurement of obesity is based on Body
    Mass Index (BMI)
  • BMI calculation
  • divide your weight in pounds by height in inches
  • divide that number again by height in inches
  • multiply the answer in step 2 by 703
  • BMI implications
  • 18.5 - 25 ideal body weight
  • 25 - 27 potential health risk
  • over 30 significant health risk

Principles of Weight Control
  • Eat right balance of foods in moderation
  • Limit fat consumption to no
    more than 65 grams of fat
    per day in a 2000
    calorie diet
  • Exercise regularly
  • generally acceptable is
  • a workout three to
  • four times per week for a minimum
  • of 30 minutes per exercise day

Principles of Weight Control
  • Tips to change behavior
  • Set realistic goals
  • Make a commitment to change
  • Keep to your exercise schedule
  • Make healthier food choices
  • Analyze progress

Physical Fitness
  • A condition that helps one look, feel, and do his
    or her best
  • Physical fitness is individual
  • Varies from person to person
  • Influenced by
  • Age
  • Gender
  • Heredity
  • Personal habits
  • Exercise
  • Eating habits

Benefits of Physical Fitness
  • Decrease in resting heart rate and blood pressure
  • less work load greater efficiency of body
  • Increase in oxygen carrying capacity
  • Enhanced quality of life
  • Increase in muscle mass
    and metabolism
  • Increased resistance to injury
  • Improved personal appearance
    and self image
  • Maintenance of motor skills throughout
  • life

Cardiovascular Endurance
  • Fitness assessment
  • Heart rate target zone
  • 220 minus your age in years
  • and then multiply by 60-80
  • example
  • 220-25195
  • 195 x 0.6 117 beats/minute
  • 195 x 0.8 156 beats/minute
  • target heart rate is between
  • 117 and 156 beats per minute
  • during exercise

Muscular Strength
  • Strength endurance assessment
  • Principles of training
  • Isometric versus isotonic
  • isometric - no movement of joint
  • isotonic - joint moved through range of motion
  • Resistance
  • amount of weight moved or
  • lifted during isotonics
  • Sets - number of times exercise repeated
  • Frequency - minimal number of workouts needed for
    positive effect

Muscular Flexibility
  • Flexibility assessment
  • Principles of muscular flexibility
  • Intensity of exercise
  • Repetitions
  • Frequency
  • Prevention and
    rehabilitation of low back pain

Being a couch potato can be hazardous to your
Importance of Sleep
  • Sleep deprivation leads to exhaustion
  • resistance to all stressors declines
  • increased susceptibility to physical
    psychological ailments
  • Disruption of circadian timing system
  • Circadian (Latin for about a day) rhythm -
    biological cycles that occur about every 24 hours
  • Includes hormonal body temp
  • changes, appetite sleepiness
  • cycles, other body functions

Disease Prevention
  • Regular check ups with your physician is
    essential to maintaining good health

Cardiovascular Disease
  • Components with impact on preventing heart
  • Cardiovascular endurance
  • Blood pressure monitoring
  • Body composition
  • Total cholesterol/ HDL ratio
  • Triglyceride levels
  • Estrogen use
  • Stress responses
  • Periodic risk assessment

Cigarette Smoking
  • Health ramifications
  • negative effects on cardiovascular system
  • increased incidence of lung cancer
  • Why people smoke
  • Peer pressure
  • Relief of stress
  • Weight control
  • Addictive properties of nicotine
  • Smoking cessation resources available

  • The term cancer encompasses more than 100
    diseases affecting nearly every part of the body
  • All are potentially life-threatening
  • Fundamental cause of all cancer is a change or
    mutation in the nucleus of a cell
  • Most common cancers are linked to one of three
    environmental risk factors
  • Smoking
  • Sunlight
  • Diet

Steps in Cancer Prevention
  • Eliminating smoking
  • Making dietary changes
  • Minimizing sun exposure using sun screen
  • Regular physical examinations
  • Watching for the warning
  • Periodic risk assessment

Cancer Warning Signs(CAUTION)
  • Change in bowel or bladder habits
  • A sore throat that does not heal
  • Unusual bleeding or discharge
  • Thickening or lump in the breast or elsewhere
  • Indigestion or difficulty swallowing
  • Obvious change in a wart or mole
  • Nagging cough or hoarseness
  • Source The
    American Cancer Society

Infectious Disease
  • Hygiene - hand washing (20 seconds minimum) most
    effective tool to helping to keep you healthy
  • Using engineering and work practice controls
  • Reporting exposure promptly and doing follow-up
  • Periodic risk assessment

Injury Prevention
  • Job-related injuries can be minimized by being
    knowledgeable about
  • Body mechanics during lifting and moving
  • Being alert for hostile environments
  • Prioritizing personal
    safety during rescue situations
  • Practicing safe vehicle
  • Using safety equipment
    and supplies

Body Mechanics During Lifting and Moving
  • Only move a victim you can safely handle get
    additional help if needed
  • Look where youre walking or crawling
  • Move forward rather than backward
    when possible
  • Take short steps, if walking
  • Bend at hips and knees
  • Lift with legs, not back
  • Keep load close to the body
  • Keep patients body in-line when moving

Hostile Environments
  • Carefully evaluate scene for safety concerns
  • Do not enter scene until it is safe
  • Coordinate all activities with law enforcement
  • Follow protocols for establishing
    Medical Incident Command
  • Plan an entrance and escape
  • route(s)
  • Above all else, stay alert
    and be prepared for
  • unexpected

Mental and Emotional Health
  • Substance misuse/abuse control
  • Anxiety and stress
  • Personal time/meditation/
  • Family, peer, community
  • Freedom from prejudice

Warning Signs of Addiction and Addictive Behavior
  • Using a substance to relieve tension
  • Using an increasing amount of the substance
  • Lying about using the substance
  • Experiencing guilt about using the substance
  • Avoiding discussion about using
    the substance
  • Interference with daily
    activities due to substance abuse

Substance Abuse Management
  • Methods used to manage substance abuse depend on
    the type of substance being misused
  • Substance misuse/abuse control may include a
    combination of professional counseling,
    physician-controlled medication therapy, and
    support programs

Anxiety and Stress
  • Stress results from the interaction of events
    (environmental stimuli) and the adjustive
    capabilities of the individual
  • Usually seen as generating
    negative affect (fear, depression,
    guilt, etc.)
  • Stress also experienced
  • with positive events

Anxiety and Stress
  • Anxiety
  • Uneasiness or dread about future uncertainties
  • Eustress
  • Good stress
  • Response to positive stimuli
  • Distress
  • Bad stress
  • A negative response to an
    environmental stimulus

Meditation and Contemplation
  • Setting aside some personal time for meditation
    and contemplation can greatly enhance mental, and
    perhaps even physical,

  • A unique characteristic of human existence
  • Should not be overlooked as an effective means
    for some to achieve mental and physical well-being

Family, Peer, and Community Connections
  • Belonging to groups can affect a persons
    motivation and performance in very positive ways
  • People tend to associate with others most like
    themselves (e.g., family members,
    coworkers, members of community
    and religious organizations)
  • These groups provide a connection
    with people who share similar values
    and interests

Freedom From Prejudice
  • Acceptance of cultural differences
    allows individuals to
  • Learn about other cultures
  • See cultural variations in a
    positive light
  • Affirm the value of these differences

Freedom From Prejudice
  • Acceptance of individual differences
  • Recognize existence of differences
  • Listen until you can tell
    the other person's story
  • Work toward
    win-win solution

Stress Management
  • Stress is a state of physical or psychological
  • Hazard of emergency work
  • Always present to some degree
  • EMS providers must manage stress
  • to prevent Burnout
  • 3 phases of stress response
  • Alarm reaction
  • Resistance
  • Exhaustion

3 Phases of Stress Reaction Phase 1 - Alarm
  • Fight or flight phenomenon
  • Considered to be positive takes only seconds to
    become activated
  • Prepares individual for action/self-defense
  • Mediated by the sympathetic nervous system branch
    of the autonomic nervous system

Alarm Reaction
  • Fight or flight phenomenon
  • Physiological response
  • Increased heart rate
  • Increased blood pressure
  • Pupillary dilation
  • Excessive perspiration
  • Relaxation of bronchial tree
  • Increased blood glucose levels
  • Slowed digestion
  • Sense of anxiety
  • Alarm reaction ends when body realizes the event
    is no longer dangerous

Phase 2 - Resistance
  • The individual begins to adapt to the stress
    through the use of defense mechanisms.
  • Reaction to stressor may change with time.

Phase 3 - Exhaustion
  • Prolonged exposure to the same stressors leads to
    the exhaustion of an individuals adaptation
    energy. Signs of the alarm reaction reappear,
    and are more difficult to reverse.
  • Increased susceptibility to physical
  • and psychological ailments
  • Rest and recovery
  • are needed

Factors that Trigger the Stress Response
  • Examples include Loss of something that is of
    value Injury or threat of injury Poor health
    or nutrition Frustration Ineffective coping

Causes of Stress in EMS
  • ?Environmental
  • Siren noise
  • Inclement weather
  • Confined work places
  • Rapid scene response
  • Life and death decision making
  • ? Psychosocial
  • family relationships
  • conflicts with supervisors, co-workers
  • abusive patients

Causes of Stress in EMS
  • ? Personality
  • Need to be liked
  • Personal expectations
  • Feelings of guilt and anxiety

Reactions to Stress
  • Vary with individuals
    and affected by
  • Previous exposure to the stressor
  • Perception of the event
  • Experience
  • Personal coping skills

Three Types of Stress Reactions
  • Acute Stress Reaction
  • a reaction that occurs soon after a catastrophic
    event has powerful impact on person
  • Delayed Stress Reaction
  • occurs days, weeks, or months after a critical
    incident also called
  • post-traumatic stress disorder
  • Cumulative Stress Reaction
  • continuous exposure to stressors
  • burnout

Delayed Stress Reaction - Post-Traumatic Stress
  • Effects
  • marital problems, alcohol drug abuse,
    personality changes, increased suicide incidence
  • Signs and Symptoms
  • Re-experiencing the traumatic event
  • Diminished responsiveness to the external world
  • Interpersonal relationships altered
  • Hyper-alertness
  • Difficulty sleeping
  • Survivor guilt
  • Memory impairment
  • Avoidance of any activities that may cause recall
    of event
  • Avoidance of thoughts or feelings associated with
    the incident

Physiological and Psychological Effects of Stress
  • Anxiousness in certain situations
  • or unusual circumstances is
  • normal a warning system for self-protection
    preparation for action
  • Detrimental reactions to anxiety/stress -a
    continued state of alertness beyond the state of
    the emergency self-preparation for danger has
    not been reduced

Physical Effects of Anxiety/Stress
  • Heart palpitations
  • Difficult/rapid breathing
  • Chest tightness/pain
  • Anorexia
  • Flushing, diaphoresis
  • Sleep disturbances
  • Aching muscles and joints
  • Backache, headache

Emotional Effects of Anxiety/Stress
  • Panic reactions
  • Fear
  • Anger
  • Denial
  • Feeling overwhelmed

Cognitive Effects of Anxiety/Stress
  • Difficulty making decisions
  • Disorientation, decreased level of awareness
  • Memory problems, poor
  • Distressing dreams

Behavioral Effects of Anxiety/Stress
  • Crying spells
  • Hyperactivity
  • Withdrawal
  • Changes in eating
  • Increased smoking
  • Increased alcohol consumption
  • Drug abuse

Adaptation to Stress
  • Dynamic, evolving process whereby one learns
    successful ways to deal with stressful situations
  • This process
  • Usually begins with using defense mechanisms
  • Coping skills then developed
  • Followed by problem solving
  • Culminating in mastery

Defense Mechanisms
  • Adaptive function of personality
  • Assists in adjusting to stressful situations
  • Helps in avoiding dealing with problems
  • Defense mechanisms
  • repression - involuntary banishment of
    unacceptable ideas or impulses into the
  • regression - return to an earlier level of
    emotional adjustment
  • projection - attributing to another person those
    thoughts, feelings, motives, or desires which are
    really ones own unacceptable traits

Defense Mechanisms continued
  • rationalization - process of ascribing acceptable
    or worthwhile motives to feelings, thoughts, or
    behavior which really have other unrecognized
  • reaction formation - direction of overt behavior
    or attitudes in precisely the opposite direction
    of the individuals underlying, unacceptable
  • denial - unconscious disavowal of thoughts,
    feelings, wishes, or needs which are
  • consciously unacceptable

Responding to Stress
  • Coping
  • active, confronting process
  • information gathered/used to change
  • or adjust to a new situation
  • Problem solving
  • healthy approach to everyday concerns
  • uses problem analysis, option analysis for
    action, determination of course of action
  • Mastery
  • ability to see multiple option/potential
  • results from experience with similar situations

Stress Management Techniques
  • Methods used to initially manage stress include
  • Reframing
  • Controlled breathing
  • Progressive relaxation
  • Guided imagery

Stress Management
  • Reframing
  • looking at situation from different point of view
  • Controlled breathing
  • natural stress reliever creates calm
  • Progressive relaxation
  • tighten/relax particular muscle groups fools
    body into thinking it is relaxing
  • Guided imagery
  • guided thru stress response by concentrating on
    an image that helps relieve stress

Other Stress Interventions
  • Being aware of personal limitations
  • Peer counseling and group discussions
  • Proper diet, sleep, and rest
  • Pursuit of positive activities outside of EMS to
    balance work and recreation
  • Utilizing other intervention programs that may be
    available through EMS agencies, hospitals, and
    other groups

Critical Incident Stress Management
  • CISM is an organized, formal, peer and mental
    health support network and process
  • Enables emergency personnel to vent feelings
  • Facilitates understanding of stressful responses
  • Reassures personnel that what they are
    experiencing is normal and may be common to
    others involved in the incident

  • Situations in which CISM should be considered
  • Line of duty injury or death
  • Disaster
  • Emergency worker suicide
  • Infant/ child death
  • Extreme threat to emergency worker
  • Prolonged incident regardless if end is loss or
  • Victims known to operations personnel
  • Death/ injury of civilian caused by operations
  • Other significant event

Components of CISM
  • Pre-incident stress training
  • On-scene support to distressed personnel
  • Individual consults
  • Defusing services immediately after a large scale
  • Mobilization services after large scale incident
  • Critical incident stress debriefing 24 to 72
    hours after an event
  • Follow-up services
  • Specialty debriefings to non-emergency groups in
    the community
  • Support during routine discussions of an incident
  • Advice to command staff during large scale
  • 1-800-225-2473

  • Informal gathering of the people involved in the
    event and two-person CISM-trained teams who are
    also peers
  • Usually takes place within 8 hours after an event
  • Allows initial release of feelings
  • Allows opportunity for people to share their
  • Usually lasts lt one hour

  • More formal than a defusing
  • Conducted in a confidential setting
  • Usually takes place 24 to72 hours after the event
  • Conducted by a specially trained CISM team of
    other emergency services personnel and mental
    health workers
  • Only those present at the incident
    are allowed to attend a debriefing

Reducing Crisis-induced Stress
  • Taking care of the care taker
  • Appropriate rest breaks
  • Replacement of food and fluids
  • Limitation of exposure to incident
  • Change of assignments
  • Providing post-event defusing/ debriefing
  • Studies note that most people will recover
    naturally from stressful situation

Death and Dying
  • Elizabeth Kubler-Ross found that most people go
    through 5 stages of grief
  • Denial - no, not me
  • Anger - why me?
  • Bargaining - okay, but first let
  • me...
  • Depression - yes, me in mourning
  • withdraws, retreats
  • Acceptance - okay, Im not afraid family may now
    need more support

Conveying News of a Sudden Death
  • Gather family in a private area
  • Advise them of patient's death, with a brief
    description of circumstances causing the death
  • The words death or dead should be used
  • Be compassionate
  • Allow family to see their relative if they
    choose prepare family in laymen terms of what
    they may see

Common Needs of the Paramedic when Dealing with
Death and Dying
  • Paramedic may experience some of the stages of
  • Support from friends, coworkers, family
    following incident
  • Opportunity to process specific incident and
    obtain closure important
  • Use available resources to avoid effects of
    cumulative stress

Developmental considerations when dealing with
death and dying
  • Newborn to age three
  • Children will sense that something has happened
    in the family.
  • Children will realize that people are crying and
    are sad all the time.
  • Children will realize that
    there is much activity in
    their household.

Developmental considerations when dealing with
death and dying
  • Newborn to age three
  • Watch for changes in
  • Eating or sleeping patterns
  • Irritability
  • Suggestions
  • Be sensitive to the childs needs
  • Try to maintain consistency in routines
  • Maintain consistency with significant people in
    the childs life

Developmental considerations when dealing with
death and dying
  • Three to six years of age
  • Child does not have concept of the finality of
  • Believes that the person will return and will
    continually ask when the person will return
  • Believes in magical thinking (feels responsible
    for the death)
  • Child may believe that everyone
  • else they love will also die

Developmental considerations when dealing with
death and dying
  • Three to six years of age
  • Watch for changes in
  • Behavior patterns with friends and at school
  • Difficulty sleeping
  • Changes in eating habits
  • Suggestions
  • Emphasize to the child that he was not
    responsible for the death
  • Reinforce that when people are sad they cry
    crying is normal and natural
  • Encourage the child to draw pictures of his
    feelings, or talk about his feelings

Developmental considerations when dealing with
death and dying
  • Six to nine years of age
  • Beginning to understand the finality of death
  • Will seek out detailed explanations for the death
  • Will be afraid other significant people in their
    lives will die as well
  • Be uncomfortable in expressing feelings. May act
    silly or embarrassed when talking about death

Developmental considerations when dealing with
death and dying
  • Six to nine years of age
  • Suggestions
  • Talk about the normal feelings of anger, sadness
    and guilt
  • Share your own feelings about death do not be
    afraid to cry in front of the child- this gives
    the child permission to express their feelings

Developmental considerations when dealing with
death and dying
  • Nine to twelve years of age
  • Aware of the finality of death
  • Concerned with practical matters concerning the
    childs lifestyle
  • May want to know all the details surrounding the
  • May try to act like an adult, but then show
    regression to an earlier stage of emotional

Developmental considerations when dealing with
death and dying
  • Nine to twelve years of age
  • Suggestions
  • Set aside time to talk about feelings
  • Encourage sharing of memories to
    facilitate grief response

Developmental considerations when dealing with
death and dying
  • Elderly
  • Concerned about other family members
  • Concerned about further loss of independence
  • Concerned about cost

Quotes to Think About...
  • Every human being is the author of his own health
    or disease.
  • Author Sivananda
  • No rain - no rainbow.
  • Author unknown

Well-Being of the Paramedic
  • Material prepared by
  • Brian Sobeck, BA, NREMT-P (NIEMSCA)
  • Modifications by
  • Sharon Hopkins, RN, BSN,EMT-P
  • Questions ??